Intractable Postpartum Haemorrhage Managed by Angiographic Embolization: Case Report and Review

EDITORIAL COMMENT: We accepted this case report because it gives a comprehensive review of a technique that should be available in all major centres although not in obstetric institutions unless affiliated with a general surgical hospital. Table I shows that angiographic embolization was successful in most cases reported in the literature but so too is ‘return to theatre’ surgery even if the patient requires more than one such journey. The case reported here was one of secondary postpartum haemorrhage. The technique of embolization is less likely to be suitable in a case of continuing primary postpartum haemorrhage after Caesarean section or Caesarean hysterectomy although this would depend upon the circumstances of the previous surgery and whether or not resuscitation and control of coagulation failure had been problems. Also a patient who has a haemoperitoneum requires reoperation; moreover, it is sometimes difficult to know whether there is a haemoperitoneum or not in these patients and this is often the case when there is a postoperative problem. The authors make the important point that bilateral internal iliac artery ligation may not control haemorrhage even from the region of the vaginal vault, a comment referred to previously in this journal This paper gives a comprehensive review of the literature on this subject and should interest many readers. A.  Return to theatre - experience at the Mercy Maternity Hospital, Melbourne 1971–1982. Aust NZ Obstet Gynaecol 1985; 25: 159. B.  Internal iliac and ovarian artery ligation in the control of pelvic haemorrhage. Aust NZ Obstet Gynaecol 1989; 29: 22. Summary: A case of intractable postpartum haemorrhage successfully managed by angiographic embolization is presented. The literature concerning angiographic embolization and internal iliac artery ligation is reviewed. Angiographic embolization is a superior method to internal iliac artery ligation in appropriately selected cases of obstetric haemorrhage, and may also be used successfully in cases where internal iliac ligation and/or hysterectomy has failed to control pelvic haemorrhage. Angiographic embolization is a potentially life- and fertility-saving procedure.